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15030118 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10241 JOHNSON AVE CONTRACTOR:CURRO PLUMBING INC PERMIT NO:15030118 OWNER'S NAME: BULL FAMILY 5810 OBATA WAY STE 8 DATE ISSUED:03/19/2015 O R'S PHONE: 4084698474 GILROY,CA 95020 PHONE NO:(408)847-7704 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ .megRELOCATE(E)METER FROM SIDE YARD TO FRONT PER License Class Lic.# �7 PG&E REQUIREMENTS Contractor Date I hereby affirm that I am licensed and a provisi s of 46hapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2660 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:37518027 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS D INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 3 }� granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-p int source ulati per the Cupertino Municipal Code,S tion 9 18. ` RE-ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby a irm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Qual' Management District I performance of the work for which this permit is issued. will maintain compliance with t Cupertino Muni ' a Code,Chapter 9. anji I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety JScc25505, 33, 5534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized Dater permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker'sCompensation laws of California. If,after making this certificate of exemption,I ION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that thervitiscissued onstruction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this pe (Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 918. Signature Date GENERAL PERMIT APPLICATION ` MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255ilia f Clic PEFtTIN4 (408)777-3228•FAX(408)777-3333•building(a)cupertino.org misc PLUMBING [:]MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS /� / f� l 77N# OWNER NAME STREET ADDRESS CITY, FAX CONTACT NAME 0_6, /O.I ` �/� PHONE Z/Br' E-MAIL ,f� tit STREET ADDRESS Vj// S/�J/(� CITY,STATE,ZIP6,& � (Z1�C 9w� FAX (•'� f ❑ OWNER ❑ OWNER-BUILDER 1:1 OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHrrECTT 11 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR s LICENSE NUMBER,--5n� LICENSE TYPE/, , f BUS.LIC# COMPANY N �VT� C/uA09 T E-MAIL Q'V (j Jfi FAX STREET ADDRESS }o ami•/�(,J � CITY,STATE,ZIP I�� /j ,��y?#j PHON 00(y"?� ARCHITECT/ENGINEER NAME =''+9 LICENSE NUMBER ` Coe �( (/(/ BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN Wn.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL 1111�� URBAN INTERFACE AREA ❑ NO FLOOD I ❑NO��11 EICHLER HOME? ❑ NO DESCRIPTION OF WORK R - Aireie 1�6 we TOTAL VALUATION: RECEI By my signature below,I certify to each of the following: I am tl property owner or authoriz ent t e owner's behalf. I have read this application and the infonnation I have ovided is co I e ad the Description of Wor and it is accurate. I gree to inply w' all applicable local ordinances and state laws relating to b i g cons n. au a represe tives of Cupertino to enter the ab a-i ti rope r inspection purposes. Signature of Applicant/Agent: Date: S PL TAT,INFORMATION REQUIRED W� O(�,'ER THE-COi7J,YTERyp�� , . � & MEPMiscApp_201Ldoe revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10241 JOHNSON AVE DATE: 03/19/2015 REVIEWED BY: MELISSA APN: 375 18 027 BP#: *VALUATION: $2,660 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 RPGAS USE: p PERMIT TYPE: WORK RELOCATE E METER FROM SIDE YARD TO FRONT PER PG&E REQUIREMENTS SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Piping, Gas >4 Outlets 1BPGAS 1 # $72 TOTALS: $ $72.00 a t Rom 7W Alec%. Plan Check Plumb.Plan Check 0.0 hrs $0.00 E/ec..Plcan Check :Meeh. Permit Fee: Plumb.Permit Fee: IPPERMIT klec. Permit Fee Otter Alech. /rasp Other Plumb Insp. I.LOJ hrs $48.00 Other 1,lec.Inch. i ieck. Irish. Fee: Pharnb. Insp.Fee: I lec.Insh. Fee: ELI—Li NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Theseees are based on the prelfinina information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS(Fee Resolution 11-053 Ef. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: suppl. P("Fee F PME Plan Check: $0.00 Permit Fee: sagyd. ]rasp Fee PME Unit Fee: $72.00 PME Permit Fee: -TT $48.00 Cvnstroction Tax: Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 � $214.50 $0.00 ' ',tee T O AL°FEEt $214.50 Revised: 02/14/2015 i Ch „Ufa -CUrEg i llvn BUtLt�1N�a 1pma uie+� , This set of plans and specificatians MUST be kept at the is unlawful t job site during constrations On same, or to deviate e any changes or alte ., g .1 therefrom,without approval from the �dl��r' �"'''a: c The Stamping I this plan and sp�ificatiors �,t��L �0 be held to permit or to be an approval of t” �'tclaticn finance or Stae of a _ DATE U l/ PE 1-r NO. CUPERTINO `k-,, Building Cepa,ent V�l � 19 2015 MAR IEWEU FOR CODE COMPLIANCE REVReviewed BY. Lt ED CIV ` l LIAR 10 2015 PY OFFICE ;6